| NPI | 1447663844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101024374) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT015956) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2018-08-08 |